The Effortful Swallow Exercise

Exercise of the Month: The “Effortful” Swallow (aka the Modified Valsalva maneuver, or the “Hard Swallow”)

Sometimes the best practice for swallowing is swallowing itself. How you do it, can make all the difference. The exercise is just as the name implies, you swallow with effort or HARD! That’s right, with GUSTO. The goal of this technique is to recruit more motor units, increase the demand and create a muscle training/strengthening effect. This technique is used to protect the airway. How does using this technique protect the airway? When there is muscle weakness due to various conditions, such as head and neck cancer, stroke or general de-conditioning, the muscles of the tongue and pharynx may not be doing their part to push, lift or squeeze to propel food out of the mouth and throat. The result of a weak muscle contraction(s) is often that food or liquids “pool” in the mouth or pharynx (throat) after the swallow. After swallowing, residual food and liquid in the mouth and throat are likely to overflow into the unprotected airway and cause what is known as aspiration.

When I instruct patients in the Effortful Swallow, I usually tell them to pretend to “swallow a grape whole” or some patients prefer “swallow the vitamin whole, without water”. Patients who have a lot of saliva or mucus in the throat and feel that they can’t swallow can use this technique to try to get the saliva down. If someone is having trouble swallowing saliva (secretions), I usually pair this exercise with visual reminders to practice this often. For example, some patients put up ‘Post It’ notes all around the house that say “SWALLOW!”, so that there are visual reminders in the house to get those muscles working! Another strategy is to wear a brightly colored bracelet, or put a dot on the face of a watch (for the clock watchers) as a reminder to swallow (and swallow HARD) every time they see the reminder.

If you can swallow your saliva and aren’t spitting into a Kleenex, you can try chewing gum and using the Effortful Swallow while chewing. Keep sessions limited to 10 minutes and concentrate on each swallow. If your mouth gets dry, you can use a spray mister (bottle) and wet your mouth to give you something to swallow.

This therapy technique is attributed to Jerilyn Logeman (1989), one of the pioneers of dysphagia (swallowing) evaluation and therapy and the “inventor” of the Modified Barium Swallow Study. Therapy techniques are usually classified as indirect or direct. Indirect means it can be done without food used. Direct therapy techniques are used during swallowing of food or liquids. The Effortful Swallow can be used as an indirect or direct therapy technique. If you are not yet able to handle food, this one may be for you! Ask your therapist.